Lab Matters Summer 2019 - Page 63

APHL 2019 POSTER ABSTRACTS reveal new clusters of potentially related cases. Optimizing culture- independent enrichment yielded up to 90% B. pertussis sequencing read data and significantly reduced host contamination, sufficient for wgMLST directly from clinical specimens and comparison to cultured isolates. These results illustrate the utility of wgMLST for improving B. pertussis characterization and the addition of culture-independent enrichment has the potential to increase case representation, together aiding molecular epidemiology and genomic study of the current pertussis disease resurgence. Presenter: Michael Weigand, Centers for Disease Control and Prevention, Atlanta, GA, yrh8@cdc.gov Adoption and Adaptation: A Public Health Laboratory’s Experience Implementing Carbapenem Resistance Mechanism Surveillance S. Matzinger, K. Johnson, L. McCoy, S.E. Totten and E. Travanty, Colorado Department of Public Health and Environment In recent years, infections caused by Carbapenem-resistant organisms (CROs) has become a significant public health issue worldwide. The increase in observed resistance is linked to the expression of an ever-increasing number of enzymes capable of degrading this class of broad-spectrum antibiotic drugs. In response to this concern, Colorado Department of Public Health and Environment (CDPHE) Laboratory implemented the Antibiotic Resistance Laboratory Network (ARLN) surveillance algorithms recommended for detection of Carbapenem resistance mechanisms in gram negative bacteria and adopted these testing schemes to the particular needs of our state. In recent years, CDPHE has identified multiple areas for improvement in our testing scheme that have resulted in an overall increase in efficiency, as well as an expansion in mechanism detection capabilities. Specific improvements evolved from a need to test an ever-growing number of isolates possibly harboring an increasing range of known resistance mechanisms. CDPHE performed process improvement by blending the capabilities of multiple molecular detection assays in order to survey for as many known mechanisms as possible. In addition, we performed method extensions for MALDI-TOF isolate identification of CROs in order to enhance robustness, increase overall testing capacity, and decrease turnaround times. This poster will describe the specific CDPHE laboratory derived policies developed in response to the growing concern of Carbapenem resistance mechanism emergence and expansion. in the state and to also raise awareness among members of the public. Positive rabies virus samples almost doubled from 162 in 2017 to 280 in 2018. During the first half of 2018, the Colorado Department of Public Health and Environment (CDPHE) Laboratory Services Division received a total of 169 skunks from Denver and El Paso counties, of which 81% were positive for rabies. Denver and El Paso counties also had 80% of the total rabies positive skunks for the entire state of Colorado. Once it was realized that both Denver and El Paso counties were having epizootics of rabies in local skunk populations, it was evident that there was a need to develop a “right sizing” plan. This volume of testing simply could not be supported by the budget or personnel available. The goals of the initial surveillance had already been accomplished, therefore fee-waived testing was limited to cases of public health importance (a known exposure or an animal found in a public area). The second half of 2018 saw a reduction from 169 to just 14 skunks submitted for testing (10 of which were positive for rabies). This allowed us to focus our limited resources and trained personnel on the other 860 samples submitted for rabies testing from other areas of Colorado which do not have epizootics of rabies. Rabies is a part of Colorado, and as positive rabies virus samples continue to increase, balancing right sizing with testing capacity will allow us to provide adequate rabies testing services as we head into 2019. Presenter: Ryan Bagg, Colorado Department of Public Health and Environment, Denver, CO, ryan.bagg@state.co.us Impact of Nontuberculous Mycobacterium Changing Guidance on Public Health: A Laboratory Perspective and Preparedness Plan S.E. Totten, K. Xavier, H. Webber, T. Regan, E. Travanty and S. Matzinger, Colorado Department of Public Health and Environment In 2015, only 5 jurisdictions required Nontuberculous Mycobacterium (NTM) notifications in a public health setting. In 2016 that number had increased to 11 jurisdictions. Little change has occurred since 2016 despite increased reporting of NTM presence within exposures and the environment. R. Bagg, B. Steidley, K. Mayo, J. Knutsen, S.E. Totten, E. Travanty and J. House, Colorado Department of Public Health and Environment In 2019, Colorado requested notification of all NTMs through a Board of Health proposal. This created several public health laboratory challenges. Public Health has always needed to answer the question “TB or Not TB” and has had guidance on further activities if a specimen/isolate was identified as TB. All samples that were deemed “Not TB” were no longer of public health concern. Public Health laboratories are often set up to perform TB determination based on CIDT and then only culture if the specimen is TB for antimicrobial susceptibility testing (AST). With report requirements, not just public health laboratories but also clinical laboratory colleagues will need to become proficient in NTM cultivation and identification. Our goal is to provide low cost identification of NTM for our stakeholders that do not currently support NTM identification. This poster represents our road to expertise. As one of the deadliest viruses on Earth, any amount of rabies is too much. Unfortunately, in Colorado we do not have a say in the matter. Prior to the 2018 rabies season, Colorado had policy in place to use the Colorado General Fund to waive rabies testing fees on rabies reservoir species that were submitted for surveillance purposes (no known human or animal exposures). This was done to provide improved data showing where terrestrial rabies had spread Our first step on this journey was to enhance our practice to ensure optimal recovery. We started with the gold standard methodology for Acid Fast Bacilli (AFB) specimen isolation including 3 media types: broth, LJ slants and 7H11 bi-plates. Depending on the specimen type, additional 7H11 bi-plates may be added for incubation at 320C, RT and 420C. Media will be incubated for 42 days minimum and up to 8 weeks for LJ slants. Presenter: Shannon Matzinger, Colorado Dept. of Public Health and Environment, Denver, CO, shannon.matzinger@state.co.us How Much Rabies Is Too Much Rabies? PublicHealthLabs @APHL APHL.org Summer 2019 LAB MATTERS 61